How I made disability education a priority at the University of Virginia
By Kayla Karvonen
As a medical student at the University of Virginia (UVA), I have worked to build a medical curriculum more responsive to the needs of individuals with disabilities. When I started medical school, I expected training targeted at caring for individuals living with disabilities, if for no other reason than the fact that nearly one in five Americans — more than 50 million people — have a disability. However, I was disappointed in how little we learned about this population. I walked into patient encounters with individuals with intellectual disabilities and their caregivers and felt uncomfortable modifying my interview approach and question base. I fumbled with modifying my physical exam techniques to examine persons with limited mobility. I felt that through my ignorance I was contributing to the problem instead of helping to create a solution.
During my undergraduate and medical education I had the pleasure of interning with Lex Frieden, an architect of the Americans with Disabilities Act, and thus had my first peek inside the world of disability. I researched barriers to preventative health screening for Houstonians with disabilities and was shocked at the healthcare disparities I witnessed. The problem was multifactorial. From the infrastructure of the healthcare system itself to the imperfection of the individual physician I found plenty of opportunities for people with disabilities to receive substandard care. I also saw plenty of opportunities for collective improvement.
As an aspiring physician, I wondered how I can be expected to provide care to a community without knowing anything about its culture, history, and needs. For that reason, and on behalf of others like me, I researched current medical curricula across the country and wrote a call to action for medical schools to integrate formal disability education into their curriculum. The guideline included ways to incorporate comprehensive coverage of disability including content requirements, examples of pilot programs, and suggestions for implementation. While the literature on this topic is itself unacceptably limited, it offers a glimpse into successful approaches in teaching future physicians to provide competent care for people with disabilities.
At my own institution, UVA, I partnered with Dean Christine Peterson, MD to create the Caring for Persons with Disabilities Initiative. We developed and presented a disability thread unanimously approved by the UVA curriculum committee in February 2016 with Alan Alfano, MD, medical director of UVA-HealthSouth Rehabilitation Hospital, as the thread leader.
Curriculum threads represent cornerstones of medicine and include pathology, anatomy, sexuality, etc. Each thread has a set of learning objectives students are to master before graduating and practicing medicine under the supervision of attending physicians. Thread learning objectives are interwoven into lectures, small group activities, and clinical skill sets throughout all four years of medical school.
By establishing a disability thread we have created a sustainable infrastructure to insert learning opportunities throughout a student’s training from the white coat ceremony to graduation day. From the moment I voiced my concerns, faculty at UVA have been incredibly supportive and have made disability education a top priority. I encourage any medical student to be transparent with your concerns and to be an advocate for the underserved. You may be surprised to find a wealth of resources and eager administrators to be your allies. My hope is that creating UVA’s disability thread is a small step towards training the next generation of physicians to be confident and competent in caring for persons with disabilities consequently reducing healthcare disparities and increasing patient satisfaction.
Essentials for making disability education a priority in medical schools
- Dedicated faculty members organized into a task force including members of the disability community, physiatrists, neurologists, physical therapists, occupational therapists, speech therapists, and nurses
- Specific learning objectives for students to master
- Presentation of demonstrated need and plan to create sustainable infrastructure to address that need to the curriculum committee
- Commitment from the medical school administration
- Input from the disability community
- Comprehensive, longitudinal effort
Kayla Karvonen is a medical student at the University of Virginia.
Please see physiatry.org/UVA for examples of educational materials we have thus far implemented at UVA.
